tbuckley/cabot-search huggingface dataset:
Staff experiences with remote work in a comprehensive cancer center during the COVID-19 pandemic.
Authors: Christopher McChesney, Melanie Lynn Powis, Osvaldo Espin-Garcia, Lyndon Morley, Saidah Hack, Monika K. Krzyzanowska
Journal: Journal of Clinical Oncology (2022)

41 Background: The COVID-19 pandemic led to the rapid implementation of remote work, but few studies have evaluated the impact on staff and care delivery in healthcare settings. Utilizing a cross-sectional survey, we evaluated the experience of working remotely among clinical staff at the Princess Margaret Cancer Centre, Toronto, Canada. Methods: “Remote work” was defined as any work (tasks, projects, healthcare delivery) performed from home. A Qualtrics survey was disseminated via email three times from June-August 2021 to 1,168 physicians, nurses, allied health, and administrative staff involved in patient care. The survey evaluated staff perceptions of productivity, efficiency, patient safety, quality, and personal experiences. Results were summarized using descriptive statistics. Associations between respondent demographics and responses on perceived efficiency, desire to work remotely, support and safety/quality were evaluated using multivariable binary logistic regression models. Free-text responses were categorized into facilitators and barriers, and summarized using qualitative descriptive analysis. Results: Most respondents (n = 333; response rate: 28.5%) were female (61.3%) and physicians (23.1%). Few respondents (1.5%) worked remotely more than half the time pre-COVID which increased to 66.6% during COVID-19. Majority reported that remote work positively impacted productivity (61.8%) and efficiency (57.6%) and expressed interest in continuing (79.0%) beyond the pandemic. While most respondents agreed with the switch to remote work (89.2%), few were provided with the necessary equipment (14.1%). Some respondents perceived a negative impact on the safety (13.8%) or quality of care (18.6%) delivered remotely. Across clinical roles, compared to administrative staff, physicians were more likely to report remote work having a negative impact on productivity (OR = 24.04, 95% CI: 2.71-213.00), being dissatisfied with remote work (OR: 8.41, 95% CI: 1.37-51.64), being dissatisfied with training available (OR: 2.70, 95% CI: 0.95-7.67), and disagreed with continuing to utilize remote work beyond the pandemic (OR: 16.61, 95% CI: 1.45-190.14). Improved efficiency, less commuting, and improved work-life balance were perceived as facilitators of remote work. Barriers included a lack of clear role expectations, issues accessing clinical applications and out-of-pocket expenses. Conclusions: Our findings indicate that remote work may be a viable model in hospitals beyond the pandemic. Given the variation in experience and perceptions depending on clinical role, addressing barriers and formal evaluation of the impact of working remotely on productivity, efficiency and quality of care should be considered to inform long-term adoption.
Prognostic factors in nonsmall cell lung cancer: insights from the German CRISP registry
Authors: Martin Metzenmacher, Frank Griesinger, Horst-Dieter Hummel, Corinna Elender, Harald Schäfer, Maike de Wit, Ulrich Kaiser, Jens Kern, Martina Jänicke, Lisa Spring, Stefan Zacharias, Anja Kaiser-Osterhues, Annika Groth, Annette Hipper, Gregor Zaun, Steffen Dörfel, Björn Güldenzoph, Lothar Müller, Jens Uhlig, Michael Thomas, Martin Sebastian, Wilfried E.E. Eberhardt
Journal: European Respiratory Journal (2022)

Introduction Understanding prognosis, especially long-term outcome, in advanced nonsmall cell lung cancer (NSCLC) is crucial to inform patients, guide treatment and plan supportive and palliative care. Methods Prognostic factors influencing overall survival (OS) and progression-free survival (PFS) in 2082 patients with wild-type (WT)-NSCLC (629 M1a, 249 M1b, 1204 M1c) are reported. Patients were included in the prospective German CRISP registry recruiting in &gt;150 centres. Analysis for pre-therapeutic factors was based on results from Cox proportional hazard models. Results Current M-descriptors of the Union for International Cancer Control-8 staging system were validated: M1a and M1b patients had significantly longer median time to events compared to M1c (OS/PFS 16.4/7.2 months, 17.8/6.7 months and 10.9/5.4 months, respectively). OS and PFS were influenced by number and location of metastatic organ systems. M1c and four or more metastatic organs involved had shorter OS and PFS than M1c with one to three organs (OS hazard ratio (HR) 1.69, p&lt;0.001; PFS HR 1.81, p&lt;0.001). M1b-liver metastases had shorter OS/PFS than M1b involving other organs (OS HR 2.70, p=0.006; PFS HR 2.48, p=0.007). Based on number of involved organs (orgsys) and liver metastases, two risk groups (low-risk: M1a, M1b-non-liver, M1c-1-3-orgsys-non-liver; high-risk: M1c-liver, M1b-liver, M1c-4+-orgsys) with significantly different prognoses could be amalgamated (median OS/PFS 14.3/6.5 months and 7.7/4.1 months, respectively). Other favourable factors were female gender and Eastern Cooperative Oncology Group stage 0, with age showing no impact. Those with T1- or N0-status were associated with longer OS than T2–4 or N2–3. Conclusion In this large observational dataset, we further defined factors for outcome in WT-NSCLC, including increased number of involved metastatic organ systems and liver metastases, as those with overall poorer prognosis and reduced survival chance.
Comment on: Mesenchymal stromal (stem) cell therapy modulates miR-193b-5p expression to attenuate sepsis-induced acute lung injury
Authors: Chang Liu, Kun Xiao, LiXin Xie
Journal: European Respiratory Journal (2022)

We read with great interest the article written by dos Santos et al . [1]. Their study revealed a decrease in miR-193b-5p expression and an increase in the expression of its target gene, occludin (Ocln) in the lungs of septic mice treated with mesenchymal stem cells (MSCs). Inhibition of miR-193b-5p expression in vivo protected mice from LPS-induced lung injury. Suppression of miR-193b-5p was also found to prevent tumour necrosis factor (TNF)-induced reduction in Ocln mRNA and protein expression levels, and disruption of barrier function in an in vitro experiment. Finally, the authors also found elevated miR-193b-5p in lung autopsy specimens from patients who died of acute respiratory distress syndrome (ARDS). Opinions and comments on the article "Mesenchymal stromal (stem) cell therapy modulates miR-193b-5p expression to attenuate sepsis-induced acute lung injury" https://bit.ly/3s7t5gM
Impact of the COVID-19 pandemic on influenza and respiratory syncytial virus antibody titres in the community: a prospective cohort study in Neustadt, Thuringia, Germany
Authors: Mathias W. Pletz, Ralf Dürrwald, Janine Reiche, Norman Rose, André Scherag, Sebastian Weis
Journal: European Respiratory Journal (2022)

<b>The lack of circulation of influenza and RSV during the COVID-19 pandemic did not result in a substantial drop in respective antibody levels in the community over 12 months</b>https://bit.ly/3qXVLId
Creola bodies and pathogenesis of childhood asthma
Authors: Carl Persson
Journal: European Respiratory Journal (2022)

In their excellent review, Pijnenburg et al . [1] discuss multiple factors likely involved in inception and pathogeneses of childhood asthma, including treatments. They note significant heterogeneity of the disease, highlight inconsistent observations, and suggest that with common modes of classification phenotype stability may be poor. With development of multidimensional and systems biology approaches, they envisage that well-defined subgroups of childhood asthma will be possible. My comment rather builds on often overlooked clinical observations of association between clusters of epithelial cells, Creola bodies, in sputum samples in infants and subsequent development of asthma [2, 3]. Novel in vivo roles of exaggerated epithelial regeneration in pathogenesis and phenotyping of asthma <https://bit.ly/3y1gH50>
First histological description of pulmonary and vascular abnormalities of pulmonary hypertension associated with<i>KDR</i>pathogenic variant
Authors: Marianne Riou, Matthieu Canuet, Maria-Rosa Ghigna, Mélanie Eyries, Marie Pierrette Chenard, Michele Porzio, Anne Olland, Marc Humbert, Romain Kessler, David Montani
Journal: European Respiratory Journal (2022)

<b>This study confirms that KDR loss of function variants are associated with interstitial and pulmonary vascular remodelling, alveoli alterations, mild emphysema and possible vascular systemic involvement</b>https://bit.ly/3SmTrpW
Emporiatric Policy and Practice
Authors: Jonathan M. Mann
Journal: JAMA (1983)

INTERNATIONAL travel must be salutary, for otherwise why would more than one-quarter billion people spend nearly $100 billion (projections for the mid-1980s<sup>1</sup>) to visit foreign lands? However exhilarating international travel may be, such travelers also encounter a variety of potential health hazards, cogent reminders of the major biologic, social, and physical differences between their home countries and the regions to which they journey. Particular concern arises when travelers leave a highly industrialized nation like the United States and voyage to third-world and developing countries. Emporiatrics, the science of the health of travelers,<sup>2</sup>seems especially likely to benefit US travelers to developing areas, as the enormous differences between home and foreign environments necessitate special measures to protect travelers' health. In addition, these US travelers may be especially susceptible to unappreciated dangers because most Americans are unthinkingly accustomed to safe water, food, and swimming areas, view mosquitoes and dog bites as
Unrecognized HIV Infection, Risk Behaviors, and Perceptions of Risk Among Young Black Men Who Have Sex With Men--Six US Cities, 1994-1998
Journal: JAMA (2002)

The incidence of human immunodeficiency virus (HIV) infection among young black men who have sex with men (BMSM) is among the highest of all risk groups in the United States. Two important strategies to reduce HIV transmission among young BMSM are to increase the proportion of men who are aware of their HIV infection and to increase the consistent use of condoms among sexually active men. However, limited information is available to help develop HIV-testing and condom-promotion programs for young BMSM. To address this need, data from CDC's Young Men's Survey (YMS) were used to evaluate the prevalence of unrecognized HIV infection, barriers to testing, and reasons for nonuse of condoms among BMSM aged 15-22 years. This report summarizes the results of the survey, which indicated that of the 16% of young BMSM participants who were infected with HIV, nearly all were unaware of their infection. Few young BMSM reported testing frequently for HIV, and many reported engaging in behaviors that could transmit HIV because they perceived themselves or their partners to be at low risk for infection. These findings underscore the urgency of expanding and improving prevention efforts for young BMSM by increasing the demand for and availability of HIV-testing services and by providing high-quality prevention counseling that includes assessment and clarification of perceived risks for infection.
Addressing racial disparities in surgical care with machine learning
Authors: John Halamka, Mohamad Bydon, Paul Cerrato, Anjali Bhagra
Journal: npj Digital Medicine (2022)

Abstract There is ample evidence to demonstrate that discrimination against several population subgroups interferes with their ability to receive optimal surgical care. This bias can take many forms, including limited access to medical services, poor quality of care, and inadequate insurance coverage. While such inequalities will require numerous cultural, ethical, and sociological solutions, artificial intelligence-based algorithms may help address the problem by detecting bias in the data sets currently being used to make medical decisions. However, such AI-based solutions are only in early development. The purpose of this commentary is to serve as a call to action to encourage investigators and funding agencies to invest in the development of these digital tools.
Gynecological Electro-Therapeutics.
Journal: JAMA (1890)

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Association of historical housing discrimination and colon cancer treatment and outcomes in the United States.
Authors: S. M. Qasim Hussaini, Qinjin Fan, K. Robin Robin Yabroff, Craig Evan Pollack, Leticia M Nogueira
Journal: Journal of Clinical Oncology (2022)

69 Background: In the 1930s, the federally-sponsored Home Owners’ Loan Corporation (HOLC) created maps that directed mortgage financing based largely on a neighborhood’s racial composition. American neighborhoods were subdivided into four risk-based rankings (A – best neighborhood, B – still desirable, C – in decline, and D – hazardous and mapped in red) for mortgage approvals and denials. “Redlining” resulted in racial segregation and systemic disinvestment in communities targeted for marginalization. We investigated the association between historical housing discrimination and contemporary diagnosis, treatment, and survival outcomes in colon cancer – a leading cause of cancer deaths amenable to early detection and treatment. Methods: Individuals diagnosed with colon cancer from 2007-2017 were identified from the National Cancer Database. Individuals residing within known zip code tabulation areas (ZCTA) in 196 cities with ≥10% HOLC coverage were included. Residences were assigned a HOLC grade (A, B, C, or D) based on the majority HOLC area represented. Multivariable logistic regression models (adjusted for age and sex) were used to investigate the association of housing discrimination and late stage (stages III/IV) diagnosis, time to chemotherapy initiation, and non-guideline-concordant care (no chemotherapy, surgery, or &lt; 12 lymph node dissection). Multivariable Cox proportional hazard models with age as time scale were used to investigate the association of housing discrimination and overall survival. Results: There were 98,335 patients with new diagnoses of colon cancer with median age 68 years. Individuals residing in HOLC D were more likely to be non-Hispanic White (59%), have public insurance (46%), and income &lt; $40,000/year. Compared to people living in majority HOLC A ZCTAs, living in majority HOLC D had higher odds of a late-stage diagnosis, and living in majority HOLC B, C, or D had higher odds of non-guideline concordant colon cancer care with longer time to chemotherapy initiation. For people living in majority HOLC C and D, overall survival for all stages and late stage was worse when compared to HOLC A ZCTAs. Findings were consistent in sensitivity analysis. Conclusions: Historical housing discrimination is adversely associated with contemporary colon cancer care and outcomes. Findings underscore the importance of state-and federal-level practices on mortgage lending regulation and fair housing practices in determining equitable cancer risk, access to care, and outcomes.[Table: see text]
Drivers of palliative care and hospice use among patients with advanced lung cancer.
Authors: Megan C. Edmonds, Mayuri Jain, Melissa Mazor, Jose Morillo, Marsha Augustin, Olivia S. Allen, Amina Avril, Cardinale B. Smith
Journal: Journal of Clinical Oncology (2022)

79 Background: Despite rigorous evidence of improved quality of life and longer survival, disparities in the utilization and quality of palliative and hospice care persist for racial and ethnic minority (Black and Latinx) patients with advanced lung cancer. To better understand drivers of palliative care and hospice inequities, this study evaluated the impact of psychosocial factors (e.g., lung cancer beliefs) on palliative and hospice care utilization among minority patients with cancer. Methods: This was a prospective cohort study of 99 patients with advanced lung cancer recruited at the Mount Sinai Hospital. At enrollment, minority and non-minority patients were asked questions about their sociodemographic, clinical, and the following psychosocial factors: medical mistrust, lung cancer beliefs, palliative care and hospice beliefs. Palliative care and hospice care utilization was abstracted from patients’ medical records. Bivariate analysis examined the association between independent factors (e.g., sociodemographic, lung cancer beliefs) and outcomes of palliative care consult and hospice care use (yes vs. no). Results: Of the 99 enrolled participants, 55 (55%) were minorities with a mean age of 65 years. 42% completed a palliative care consult and 26% utilized hospice care (26%). Palliative care utilization was associated with more favorable beliefs toward palliative care (p = 0.022) and hospice (p = 0.005) and lower levels of medical mistrust (p = 0.007). Majority of the sample was not refered to palliative (50%) or hospice care (61%); however patients refered were more likely to utilize care (p &lt; 0.001). Minority patients were more likely to receive a referral and schedule a palliative care consultation compared to non-minorities (p &lt; 0.001). Self-reported minority status did not predict differences in hospice care use. Conclusions: Minority patients with lung cancer were more likely to receive a palliative care referral and specialty level consultation when compared to non-minority patients. Higher levels of mistrust were a driver of not receiving palliative care. Patient referrals appear to be an important leverage point to help mitigate disparities in palliative and hospice care use. Future work to understand factors associated with palliative care use and the impact on minority patients is needed.
Expanding the role of advanced practice providers (APPs) in cancer clinical trials.
Authors: Erin Fenske Williams, Alyssa Macchiaroli, Angela F. Bazzell, Edie Brucker, David E Gerber
Journal: Journal of Clinical Oncology (2022)

60 Background: Advanced Practice Providers (APPs) represent a growing and increasingly important component of the oncology workforce. However, APP roles in clinical research are not clearly understood, and certain policies may limit participation. For instance, National Cancer Institute (NCI) Cancer Therapy Evaluation Program (CTEP) historically prohibited APPs from signing orders on CTEP-sponsored studies, even at centers where APPs have antineoplastic privileges allowing them to order cancer treatments as standard therapy or on non-CTEP studies. At the UT Southwestern Harold C. Simmons Comprehensive Cancer Center (SCCC), more than 100 active CTEP-sponsored trials account for approximately 30% of therapeutic enrollment. Given these considerations, we approached CTEP regarding potential policy change. Methods: In early 2020, we raised the issue of disparities in allowed APP delegation between (1) CTEP trials and (2) standard practice and non-CTEP trials to NCI/CTEP leadership. Later that year, CTEP organized a discussion on the topic with SCCC representatives and other stakeholders. Subsequently, NCI deployed a survey to National Clinical Trials Network (NCTN) and Experimental Therapeutics Clinical Trials Network (ETCTN) centers asking about the role of APPs at their respective institutions. Results: Following the survey, CTEP revised its policy, allowing appropriately credentialed APPs to sign treatment orders on CTEP-sponsored trials, effective September 1, 2021. After completing required regulatory steps to update trial protocols at UTSW SCCC, approved APPs began signing cancer clinical trial treatment orders in January 2022. Since that time, the proportion of trial treatment orders signed by APPs at SCCC has increased from 1% in January 2022 to 20% in May 2022. Conclusions: The role of APPs in cancer care can be further enhanced by alleviating barriers and allowing providers to perform at the full scope of practice, thereby further integrating care teams critical to compliant and safe clinical trial participation.
Diversity, equity, and inclusion in cancer clinical trial enrollment: Laying the groundwork for a cancer center collaborative intervention through key informant interviews.
Authors: Pakhi Goel, Megan C. Edmonds, Sylvia Lin, Karyn A. Goodman, Cardinale B. Smith, Grace C. Hillyer, Nina A. Bickell
Journal: Journal of Clinical Oncology (2022)

98 Background: Clinical trial (CT) participation rates in the US are about 8% overall. Although, Black, Indigenous and People of Color (BIPOC) are as willing to join CTs as Whites, they remain underrepresented. We will implement a multi-level intervention across 3 cancer centers in New York City by creating a collaborative pool of CTs for breast, prostate, and liver cancer, thereby increasing availability of trials for all, especially BIPOC populations. To lay the groundwork, we conducted a formative evaluation to identify constructs that can influence implementation of this intervention. Methods: We designed a semi-structured interview guide for key informants to ascertain barriers and facilitators of enrollment at 1 cancer center and its 2 community affiliates. 23 key informants including oncologists, research staff, informatics, nurses, and cancer center leadership were identified using a targeted approach, followed by snowball sampling. Interviews were recorded, transcribed, and analyzed using thematic analysis approach. Results: Facilitators of accrual include patient referrals from physician-investigators and their teams, and oncologists’ knowledge of open trials through tumor boards, disease focus groups, and research meetings. Major barriers to CT enrollment are gaps in trial portfolio, inadequate infrastructure (e.g., staffing, space, and time), and incentives (e.g., RVU-based reimbursements). Informants felt that for patients, financial toxicity, medical mistrust, inadequate health literacy, comorbidities, poor performance status, and language are reasons for low accrual. Physicians emphasized their willingness to refer patients out-of-institution for CTs but lacked knowledge of outside trials. Care coordination across sites and loss of revenue for home institution are system-level barriers to referral. Additionally, informants believed that patients’ willingness to seek trials at other institutions is influenced by their commute, unfamiliarity with a new system, insurance coverage, rapport with oncologist, and motivation. Conclusions: Involving key stakeholders, increasing physician awareness of open CTs, educating patients and addressing their concerns about CTs, improving access to bilingual materials and interpreters, standardizing care coordination and ensuring similar rates of referrals across institutions are key facilitators to implement a multi-level intervention to increase CT enrollment across a cancer center collaboration.